Abstract

Background: Access to medicines in developing countries continues to be a significant problem due to lack of
insurance and lack of affordability. Chronic Myeloid Leukemia (CML), a rare disease, can be treated effectively,
but the pharmaceutical treatment available (imatinib) is costly and unaffordable by most patients. GIPAP, is a
programme set up between a manufacturer and an NGO to provide free treatment to eligible CML patients in
80 countries worldwide.
Objectives: To discuss the socio-economic and demographic characteristics of patients participating in GIPAP;
to research the impact GIPAP is having on health outcomes (survival) of assistance-eligible CML patients; and to
discuss the determinants of such outcomes and whether there are any variations according to socio-economic,
demographic, or geographical criteria.
Methods: Data for 13,568 patients across 15 countries, available quarterly, were analysed over the 2005-2007
period. Ordered Probit panel data analysis was used to analyze the determinants of a patient's progress in terms
of participation in the programme. Four waves of patients entering quarterly in 2005 were used to evaluate patient
survival over the sample period.
Results: All patients in the sample are eligible to receive treatment provided they report to a facility quarterly.
62.3% of patients were male and 37.7% female. The majority (84.4%) entered during the chronic phase of the
disease and their average age was 38.4 years. Having controlled for age, location and occupation, the analysis
showed that patients were significantly much more likely to move towards a better health state after receiving
treatment irrespective of their disease stage at the point of entry to the program (OR = 30.5, α = 1%); and that
the larger the gap between diagnosis and approval for participation in the program, the more likely it is that
patients' condition deteriorates (OR = 0.995, α = 1%), due to absence of treatment. Regressions to account for
the effect of large countries (India, China, Pakistan) did not show any important differences when compared to
the remaining countries in the sample. Survival analysis shows that at least 66 percent of all patients that entered
the program in 2005 were alive and active by the end of 2007.
Conclusions: GIPAP has a significant positive effect on patient access to important medicines for a life
threatening condition such as CML. It impacts both the progress and phase of the disease and leads to a high
survival rate. Overall, it sets a good example for access to treatment in developing countries, where such
programmes can substitute or complement local efforts to provide care to eligible patients.